Elastofibroma in Okinawa. A clinicopathologic study of 170 cases

A clinicopathologic study was made of 170 cases of elastofibroma detected in Okinawa Prefecture, Japan. A majority of the cases of elastofibroma were detected in the mainland of Okinawa and its offshore islands Tonaki-jima and Aguni-jima. The 21 cases from Tonaki Island had a familial occurrence. Simultaneously, 55 of the total cases were recognized to have occurred within the same family lines. Besides the growth of elastofibroma in the subcapsular region, there was a high rate of growth in the infraolecranons area. A case of multiple elastofibroma including the lateral thoracic wall as well as the ischial tuberosities, was also studied. In this disease, there was found to be an excessive amount of elastic material produced by fibroblasts as well as obstacles in the course of forming elastic fibers. Therefore, it was considered that this tendency was a sort of reactive hyperplasia taking place with a constitutional predisposition in the background. All cases should undergo biopsy to rule out sarcoma. No other treatment is necessary in asymptomatic patients. Local excision is all that is necessary in those with pain.

On the Mirizzi syndrome--benign stenosis of the hepatic duct induced by a stone in the cystic duct or the neck of the gallbladder

Three cases of Mirizzi Syndrome are reported. One of them was induced by the stone in gallbladder remnant. On the cholangiogram, one case showed narrowing of common hepatic duct near the porta hepatis, and one case revealed a tapered narrowing-like stenosis. Those findings resembled malignancy but closer examination could differentiate this syndrome from malignancy. Selective angiography was useful to differentiate the syndrome from malignancy. Even in the cases where stricture is severe, exstirpation of gallbladder or cystic duct, freeing the anterior wall of extrahepatic bile duct from marked hyperplasia of fibrous tissues and insertion of a T-tube as an internal splint through the stenosis were effective. It is the opinion of the authors, therefore, that the reconstruction of a strictured bile duct may not necessarily be done by resection of stricture and a hepatojejunostomy.